Pediatric Surgeon Praises Robot Helpers

Robots are increasingly found in hospital operating rooms, and at Children's Hospital Boston one surgeon says the devices are helping them perform more complex procedures less invasively and with a quicker recovery time for patients.

The da Vinci Si surgical system from Intuitive Surgical consists of a large robot with multiple arms that can be equipped with different types of surgical equipment and a two-seat console where surgeons sit to operate.

Dr. Hiep Nguyen, assistant professor of surgery at Harvard Medical School and director of the robotic surgery training center at Children's Hospital Boston, oversaw a ureteral reimplantation surgery Tuesday along with a team of surgeons and nurses. The operation was performed on a 17-year-old girl because urine was flowing from her bladder back into her kidneys, resulting in infections. In the past, the procedure was done as an open surgery, where the doctor would cut a several-inch opening in the abdomen. Recovery time was typically two to three weeks and a four-day hospital stay was required.

"But with our minimally invasive surgery provided by the robot, she's able to leave in one day, resume her normal activity in one to two days and be back in school in about seven days," said Nguyen.

Some procedures can be done laparoscopically, a less invasive type of surgery where tools and cameras are inserted into a patient through small incisions. Like robotic surgery, this also offers a shorter recovery time when compared to open surgery. However, some children are too small to be subjected to laparoscopic procedures, Nguyen pointed out, and compared to robotic surgery, the surgical field can only be viewed in two dimensions as opposed to the three-dimensional view afforded by the stereoscopic cameras on the robots.

During Tuesday's surgery Dr. Nguyen stayed close to the patient and robot, and viewed the surgery on one of several high-definition monitors. He helped guide a colleague who was sitting at the console and controlling the unit. Before moving the robot into position, the surgeon made a few incisions into the patient's abdomen into which the tools and cameras were inserted. The surgeon operating the robot sat at a console and peered into the unit, almost like looking into binoculars or a microscope, and could view the three-dimensional video. The surgeon placed his hands on the controls below the screens and controlled the robot's tools. There are also foot pedal controls.

Nguyen said that robotic surgery is relatively new and was developed in the early 1990s by the U.S. Army so that operations could be performed close to the battlefield without risking the surgeon's life.

CHB is taking advantage of the remote surgery technology, albeit not for military purposes.

"We'll be able to control a robot in another country, and this allows us to really spread our expertise," he said. "Remote surgery has taken place, but there is still a lot of technology that has to be made so that the movement is a little more seamless."

The operating room at CHB houses both the control console and the robot. The console is several feet away from the patient and can accommodate two surgeons. Typically one surgeon takes the lead and trains another on the technology.

"It's nice to have a console so that I can immediately take control if something goes wrong," Nguyen said about the system.

The hospital first purchased a robot in 2001 for about US$1.5 million to $2 million. In December 2009 it bought the current system for $2.4 million. The new unit allows for dual control, but is also smaller and faster to set up.

He said that CHB did a financial analysis to make sure that investing in the robot would be money well-spent. According to him, the hospital found that robotic surgery was 10 percent less expensive than open surgery.

"The reason for that is that it allowed patients to be out of the hospital a lot sooner, so a lot of the resources dedicated for patient post-op were able to be utilized for other patients," Nguyen said.

While he is excited about the benefits of robotic surgery there are still challenges, among them training surgeons and convincing people that this very expensive piece of equipment has an important effect on patient care.

And it is also a challenge to explain to parents that the robot is not operating on their child. "We have to tell them that the surgeon is still operating, this is just a piece of equipment," he said.

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